Your Password to Privacy: Standard Authorization Form

At one time or another, a member of your family has probably been in the hospital. You may have called the hospital to see how they were doing. It wasn’t so long ago that a nurse would ask your relationship to the patient, then offer info about your loved one’s condition. Now, it’s likely you’ll be asked for a password first.

It’s just one of the ways care providers are guarding an individuals’ protected health information (PHI). Passwords chosen by the patient and shared with family or friends is common.

Blue Cross and Blue Shield of Illinois (BCBSIL) protects its members in a similar way. All members can keep their PHI safe by using a Standard Authorization Form. 

Your Standard Authorization Form

A Standard Authorization Form lets you decide how BCBSIL can share your PHI. You can list the names of all the individuals you’d like to have access to your PHI. You can also set a timeframe so we know when permission ends and choose what information is shared.

For example, if a family member is helping with your care, you can add their name to your form. Other individuals listed might include a:

• Spouse
• Friend
• Lawyer
• Parent

You can change – or cancel – your form at any time. If you don’t want your information shared with anyone, there’s no need to use a Standard Authorization Form.

Completing Your Standard Authorization Form

The form has five pages. After reading all the instructions, the last two pages have five sections that must be completed. Here’s a breakout of what’s included:  

Section I - Enter your information
Section II - List who can get your health information
Section III - Confirm what’s shared
Section IV - Set a timeframe
Section V - Sign form to validate

We suggest keeping a copy of your final form before mailing.  You can always visit Blue Access for Members^SM (BAM)  to print new copies of the Standard Authorization Form.

Do you have questions about this or any other part of your health insurance plan? Ask us.

Originally published 1/20/2015; Revised 2018, 2021, 2023